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    <td width="1%" background="images/main_left.gif">&nbsp;</td>
    <td width="99%" background="images/main.gif" class="tieude"><img src="images/abu061.gif" width="16" height="9" />TH&Ocirc;NG TIN KH&Aacute;CH H&Agrave;NG </td>
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    <td colspan="2" valign="top"><form id="form1" name="form1" method="post" action="index.php?page=liquidate&&act=order">
      <table width="90%" border="0" align="center">
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          <td colspan="2"><u>C&aacute;c th&ocirc;ng tin c&oacute; d&#7845;u(<span class="style1">*</span>) b&#7855;t bu&#7897;c ph&#7843;i nh&#7853;p &#273;&#7847;y &#273;&#7911;!</u></td>
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          <td colspan="2"><b><u>Th&ocirc;ng tin c&aacute; nh&acirc;n:</u></b></td>
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          <td>Email<span class="style1">*</span>: </td>
          <td><?php echo $row[0];?></td>
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          <td>H&#7885; t&ecirc;n<span class="style1">*</span>:</td>
          <td><input name="txthoten" type="text" class="input-text" id="txthoten" size="30" value="<?php echo $row[1];?>"/></td>
        </tr>
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          <td>S&#7889; ch&#7913;ng minh th&#432;<span class="style1">*</span>:</td>
          <td><input name="txtcmnd" type="text" class="input-text" id="txtcmnd" size="30" value="<?php echo $row[2];?>"/></td>
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          <td>&#272;i&#7879;n tho&#7841;i<span class="style1">*</span>: </td>
          <td><input name="txtdienthoai" type="text" class="input-text" id="txtdienthoai" size="30" value="<?php echo $row[4];?>"/></td>
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          <td>&#272;&#7883;a ch&#7881;<span class="style1">*</span>: </td>
          <td><textarea name="txtdiachi" cols="40" rows="3" id="txtdiachi" class="input-text" ><?php echo $row[3];?></textarea></td>
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          <td>Ngày đăng ký: </td>
          <td><input name="ngaydk" type="text" class="input-text"  size="30" value="<?php echo $row[5];?>"/></td>
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          <td colspan="2" ><b><u>Th&ocirc;ng tin giao nh&#7853;n h&agrave;ng:</u></b></td>
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          <td width="41%" >Ch&#7885;n h&igrave;nh th&#7913;c thanh to&aacute;n<span class="style1">*</span>: </td>
          <td width="59%" ><select name="thanhtoan" id="thanhtoan">
            <option>H&igrave;nh th&#7913;c thanh to&aacute;n</option>
            <option value="chuy&#7875;n kho&#7843;n">Chuy&#7875;n kho&#7843;n</option>
            <option value="B&#432;u &#273;i&#7879;n">B&#432;u &#273;i&#7879;n</option>
            <option value="Tr&#7921;c ti&#7871;p">Tr&#7921;c ti&#7871;p</option>
          </select>          </td>
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          <td >&#272;&#7883;a ch&#7881; giao h&agrave;ng<span class="style1">*</span>: </td>
          <td ><textarea name="txtdcgiaohang" cols="40" rows="3" class="input-text" id="txtdcgiaohang"></textarea></td>
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          <td >Ghi ch&uacute;: </td>
		   <td ><textarea name="ghichu" cols="40" rows="3" class="input-text" id="ghichu"></textarea></td>
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          <td colspan="2"><div align="center">Ghi r&otilde; &#273;&#7883;a ch&#7881; b&#7841;n c&#7847;n chuy&#7875;n h&agrave;ng &#273;&#7871;n bao g&#7891;m s&#7889; nh&agrave;, &#273;&#432;&#7901;ng ph&#7889;, x&atilde;/ph&#432;&#7901;ng, qu&#7853;n/huy&#7879;n, t&#7881;nh/th&agrave;nh </div></td>
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          <td colspan="2"><div align="center">
            <input type="submit" name="Submit" value="Đặt hàng" class="button"/>
          </div></td>
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      </table>
    </form></td>
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</table>


